The final report on a cluster of teen suicides in downstate Delaware is out, but it fails to answer what triggered so many young people to take their own lives last year.

At the state's request, the Centers for Disease Control and Prevention investigated a rash of suicides in Kent and Sussex Counties between Jan. 1, 2012 and May 4, 2012. In that time, there were 11 suicide deaths and 116 attempts among young people between 12 and 21 years of age. In the first quarter alone, the number of deaths doubled the median number typically reported in the two county area in an entire year.

Heading up the investigation, Dr. Alex Crosby and his team spoke with high school personnel, crisis workers who worked directly with the teens, the state's medical examiner, law enforcement as well as hospital staff. He says all of the teens and young people suffered with two or more known suicide risk factors.

"Things like previous mental health problems or they had life stresses such as family conflict. There's, often times, an interaction of various factors that put a particular individual, in this case an adolescent or a young adult, at risk for suicidal behavior."

But why so many decided to end it all last year, or try to, remains unclear, but Dr. Crosby says within the cluster there is evidence of indirect influence of suicidal behavior from one person to another.

"In many clusters, we're just not able to identify what has caused this to spread, and what has caused it to stop," Crosby said. "When we looked, especially, at some of the nonfatal, the individuals that had engaged in non-fatal suicidal behavior is that many of them knew, or had heard about, some of the other fatalities or incidents that had occurred. And so it may be that, in some cases, those who are vulnerable, the environment triggered them to engage in suicidal behavior," said Dr. Crosby.

During the investigation, there was an additional suicide, prompting Crosby and his team to exclude interviews with students, those who attempted suicide and families from his research.

"We felt that talking with those that had directly worked with the youth... was gonna give us a pretty good idea about some of the things that were going on," Crosby said. "And [those who worked directly with some of the individuals] felt that it was too sensitive an issue to talk directly with the students."

As the state plans next steps, the report's recommendations to prevent future suicide clusters include:

Training for school staff to identify at-risk youth and connecting them to services

In his state of the state address, Gov. Jack Markell, D-Del, proposed a ten-fold increase of mental health resources in the state's middle schools effective July 1, 2014. Lt. Gov. Matt Denn is leading the effort and says currently there are only three middle schools in the entire state with qualified mental health professionals. The governor's initiative would boost that number to 30.

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